Individual
XAFSA SHUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1 COLLEGE CIR, BANGOR, ME 04401-2929
(601) 647-5820
Mailing address
1 COLLEGE CIR, BANGOR, ME 04401-2929
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN84915
ME
Other
Enumeration date
02/24/2025
Last updated
02/24/2025
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